No abstract

A 31-year-old patient, who consults with her primary care physician for presenting nonspecific abdominal pain and fullness after ingestion. Abdominal ultrasound is requested where cystic lesion is observed in the right hepatic lobe and surgical intervention is indicated with suspicion of simple cyst causing symptomatology. Results: The lesion is unroofing and its wall is sent for its pathological analysis where it is reported as a mucinous biliary cystadenoma. The patient was discharged in the fourth day In the MRI follow-up it can apreciated a new cystic lesion. It performed analysis of the content and was appreciated, higher levels of CEA With diagnosis of relapsed Biliary Cystadenoma, radical surgery is performed with subtotal exeretic surgery and fulguration of the residual wall in V segment Conclusion: Biliary cystadenomas are benign neoplasms. Complete resection is advised as preoperative diagnosis is often questionable, as well as the risk of malignant transformation into cystadenocarcinoma or sarcoma is significant. There is a very high recurrence rate in incompletely resected biliary cystadenomas A treatment algorithm has been proposed: cyst aspiration to measure CEA and CA19-9 levels, and cyst wall biopsy whenever possible.

Background: Echinococcus granulosus remains a clinical problem in rural sheep-farming communities, with HIV coinfection often seen in patients from endemic regions. Methods: Data from a prospective database was used to identify patients with and without HIV co-infection that underwent surgery for hepatic hydatid disease between 2012-2017. Clinical presentation, pre-operative intervention, surgical treatment, post-operative mortality and morbidity are reported according to the Accordion severity score. Results: Twenty-two patients (18 women, 4 men, median age 38 years, range 19-71) underwent surgery, of whom 11 (50%) were HIV positive (HIV+). Two patients in each group that presented with jaundice underwent pre-operative biliary drainage (ERCP=3; PTC=1). Four patients (2 in each group) had intra-peritoneal rupture on imaging. Three patients (27%), all HIV+, needed emergency surgery. Two HIV+ patients were found to have secondary infected cysts. Peri-cystectomy was performed in 20 patients and formal resection in 2. In 8 patients, 4 from each group, biliary communication could be identified intraoperatively. Postoperative compliations occurred in 10 patients, 5 in each group of which 9 were severe. Two post-operative deaths occurred, one in each group. Conclusion: Fifty percent of patients with hydatid disease in our service are co-onfected with HIV. HIV+ patients more often had infected cysts and more frequently required emergency surgery.